In a cohort study, Kamyar Kalantar-Zadeh, MD, PhD, of the University of California Irvine, and colleagues studied 108,635 MHD patients followed for up to 5 years. The cohort had a mean age of 64 years. The composition of the cohort was 59% diabetic, 45% women, and 33% black.

Compared with patients who had a serum phosphorus level of 7.0 mg/dL or higher and a normalized protein catabolic rate (nPCR)—a surrogate of dietary protein intake—below 0.8 g/kg/day, patients with a serum phosphorus level of at least 3.5 but less than 5.5 mg/dL and an nPCR of at least 1 but less than 1.2 g/kg/day had the greatest survival: a 51% decreased risk of death in a fully adjusted model.

The researchers noted that their results are limited by the lack data on protein binders.